Clinical Outcomes after Recovery from Severe Exacerbation in Asthma

Sim, Myoung Ki; Choi, Inseon S; Park, Seog Chea

Abstract

It is well known that asthma patients who experienced a life-threatening attack are prone to develop severe attack again resulting in hospitalization or death. Dyspnea perception impairment has been demonstrated in many patients with severe asthma, and inhaled steroids, the most effective long-term control anti-asthma medications, do not show immediate therapeutic effect. Therefore, a reduced compliance to anti-asthma treatment must be a big clinical problem. To explore clinical outcomes after recovery, 79 asthma patients who had been hospitalized due to severe exacerbation, were followed up (mean duration: 170 days). Only 35 patients (44.3%) visited the out-patient clinic regularly (OPD group), 21 (26.6%) did not take any medications, and 2 (2.6%) were dead. The OPD group patients showed no significant differences compared with the remaining patients in age, smoking, resident place, economic level, duration of asthma, dyspnea perception score, accompanying sinusitis, and post-treatment lung function. However, they included more women, had less asthma knowledge, more severe chronic asthma, and longer duration of hos- pitalization. There was no difference in the proportion of OPD group patients between near-fatal asthma (NFA) and non-NFA. However, NFA showed significantly higher rate of re-hospitalization caused by asthma exacerbation (p<0.05). Nearly half (10/21, 47.6%) of NFA were hospitalized again despite of their regular OPD visits, and 2 NFA who had not taken asthma medications died. These results showed that many patients were re-hospitalized, especially when they were NFA, and that the characteristics of OPD group patients were mostly women, and having less asthma knowledge and severe asthma.